Prehospital Emergency Care
ISSN: 1090-3127 (Print) 1545-0066 (Online) Journal homepage: http://www.tandfonline.com/loi/ipec20
Innovations in EMS Fellow Education To cite this article: (2015) Innovations in EMS Fellow Education, Prehospital Emergency Care, 19:2, 336-341 To link to this article: http://dx.doi.org/10.3109/10903127.2014.975880
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Published online: 06 Mar 2015.
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Date: 05 November 2015, At: 16:46
NAEMSP FELLOW EDUCATION ABSTRACTS Downloaded by [University of Nebraska, Lincoln] at 16:46 05 November 2015
INNOVATIONS IN EMS FELLOW EDUCATION Presented here are the ten abstracts from the second annual “Innovations in EMS Fellow Education” poster session, held at the NAEMSP Annual Meeting in New Orleans in January 2015. All submissions were reviewed by a selection committee made up of representatives of the NAEMSP Education Committee, Program Committee, and Council of EMS Fellowship Directors. Abstracts chosen for presentation are listed here reverse alphabetically by the last name of the first author. The figure and table numbers match the abstract numbers.
ments, effecting technically challenging rescue evolutions while maintaining the health and safety of rescuers and support personnel. Confined space rescue training is part of the EMS medicine core content, but can be challenging to provide. We present a unique way to teach confined space entry and rescue techniques to an EMS fellow through collaboration with a local fire department. Recent construction of a new fire station allowed for opportunities to specifically design original unique training areas within the structure to provide ready access to a variety of confined space training scenarios. Features include multiple hard points for rope work, a variety of utility models, and even floodable spaces in the basement of the structure. Due to the unique design, training can occur at any time with minimal setup and instructor preparations. These conditions could be modified for other departments, providing a ready “hands on” experience in confined space training for fellows and other learners.
1. TEACHING CONFINED SPACE RESCUE TECHNIQUES UTILIZING DEDICATED TRAINING FEATURES EMBEDDED IN OPERATIONAL FACILITIES David Wilcocks, George Lindbeck, Charles Werner, Linda Johnson, and Debra Perina University of Virginia, Charlottesville, Virginia
2. A NOVEL METHOD OF TEACHING SYSTEM DESIGN TO EMS FELLOWS
“Confined space” refers to an enclosed area with limited access presenting unique challenges to rescue operations. Examples include tunnels, storage tanks, silos, pits, manholes, ductwork, or pipes. Hazards in a confined space include suffocation by unbreathable gases, submersion in liquids or free-flowing granular solids (e.g., grain bins), collapse of unstable structures, or electrocution. Confined space emergencies are of particular concern because multiple casualties can occur when untrained rescuers succumb to the same hazard as the initial victim. Confined space training prepares rescuers to safely enter hazardous environ-
Bridgette Svancarek, Scott W. Gilmore, and Phillip H. Moy Washington University, St. Louis, Missouri Learning system design is one of the most difficult topics in EMS. Teaching it effectively is equally challenging. EMS system design is an extremely complex topic without a defined perfect delivery model. The Washington University EMS Fellowship has an effective and interesting way to overcome the challenges of teaching the concepts of system design. The Saint Louis area has several types of EMS systems (Table 2). The fellowship at Washington University is privileged to have a close working relationship with these various systems. The EMS fellows visit each agency and meet with the medical director and other EMS experts. During these meetings the following are
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the abstracts. doi: 10.3109/10903127.2014.975880
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TABLE 2. Teaching system design Type of EMS system
Third service
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Fire-based Hospital-based Private Air medical
Location
St. Charles County Ambulance District (SCCAD) St. Louis City Fire Department Christian Hospital EMS Abbott EMS (AMR) Air-Evac Lifeteam
discussed: the service delivery model, unit hour utilization ratios, special challenges the model faces, reimbursement, performance of QA/QI, and dispatch design. In addition, the fellow learns if the system uses tiered responses, flexible or specialized production strategy, static or dynamic deployment, and peak load staffing. Using this technique, the fellow learns about the diverse types of EMS delivery models and advantages and disadvantages of each. This allows the fellow to compare and contrast the numerous system delivery models and identify features unique to each system. He or she can recognize what makes a system economically efficient and clinically sophisticated, and learn how to perform system status management. This teaching style goes beyond reading the complex details of system design in a textbook or sitting in a lecture. Upon completion, the fellow is asked to design a hypothetical EMS system. Subsequently, the fellow must identify what characteristics make his or her system design superior. This allows the fellow to truly understand system design through the use of synthesis. In the end, the purpose of this teaching method is to provide our fellows with the tools to develop their own high-quality system design.
3. LONGITUDINAL EMERGENCY MEDICAL SERVICES TRACK CURRICULUM FOR EMERGENCY MEDICINE RESIDENTS IMPROVES EMS MEDICAL DIRECTION AND FELLOWSHIP CAREER PLACEMENT Andrew Stevens, Dan O’Donnell, Charlie Miramonti, and Michael Olinger Indiana University School of Medicine, Indianapolis, Indiana
Background: All residency-trained emergency physicians participate in mandated emergency medical services (EMS) education. Often emergency physicians are asked to assume medical director roles. We hypothesized that longitudinal EMS resident education provides a better model for career-sustaining EMS medical director concepts.
Objective: Implement a novel comprehensive EMS curricular track in EM residency to increase fellowship and EMS medical director career placement postgraduate training. Methods: We designed a survey to assess baseline EMS medical directorship participation. The survey was electronically administered to a cohort of EM alumni from a single academic institution. Survey feedback was used in developing a novel curriculum in 2010. This longitudinal EMS track curriculum requires residents to assume a 2-year EMS medical directorship in a large urban EMS system. Graded experience is acquired through the following components: 1) active member of a resident-paramedic prehospital ambulance unit (PGY-2); 2) independent prehospital supervisory provider (PGY-3); 3) participation in an EMS subspecialty niche (e.g., mass gathering, disaster, tactical, motorsports, air medicine). Quarterly meetings, quality improvement projects, and fellowship-trained EMS faculty mentors supplement the curriculum. Residents complete scholarly and administrative requirements within the track. Education is formalized by completion of a nationally recognized EMS medical director course as a capstone experience. Results: Fifty-six alumni participated in the survey (37% response rate), and of these, 11 (19%) selfidentified as EMS medical directors. Twenty-three residents have completed the EMS track curriculum from 2010 to date and of these, 21 (91%, p < 0.0001) were successfully placed: 14 (67%) as EMS medical directors and 7 (33%) as fellows. Conclusion: Longitudinal EMS track curricula with graded responsibilities provide a better model to teach medical director skills during residency. This model enhances EMS career development and better prepares emergency medicine resident graduates for fellowship and medical director roles.
4. EMT IMMERSION CURRICULUM FOR EMS FELLOWS WITHOUT PRIOR EMT EXPERIENCE David Schoenfeld, Paul Roszko, and Jonathan Fisher Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts A critical component to EMS fellowship education is the field experience gained during the program. Incoming fellows may have little or no prehospital experience, and may never have trained on some of the skills that are considered basic or routine for EMS providers. As part of our fellowship didactics, we developed a longitudinal curriculum that 1) addresses the need to provide fellows with fundamental EMT skills, 2) highlights the education for varying levels of field providers, 3) exposes fellows to the initial EMT
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338 certification requirements, and 4) familiarizes them with the recertification requirements for EMTs and paramedics. The program begins with a 20-hour condensed EMT course that focuses on the skills and knowledge base covered in the EMT portion of the National EMS Education Standards. The course is taught through a combination of independent reading and hands-on skill/simulation training. The sessions are taught by the clinical field supervisors (paramedics) at the fellowship’s EMS agency providing the primary field experience. This helps develop a relationship between the fellow and the field supervisors he/she will work with throughout the year. Basic EMT medications are reviewed through case-based scenarios delivered in a format similar to the EMT exam psychomotor skills station. In addition to these practical skills, there is also a focus on basic ambulance operations such as stretcher operation, lifting/moving, radio operation and etiquette, scene safety and management, and special operations. The fellow then challenges the NREMT EMT certification exam, which verifies assimilation of EMT knowledge and skills and builds “street cred” with the EMTs for whom the fellow will be providing medical oversight. During the remainder of the longitudinal program, the fellow continues to navigate the paramedic skills and knowledge base through skills stations and simulation training, ultimately challenging the NREMT paramedic certification exam. This program provides a structured mechanism that covers core clinical content and EMT/paramedic training and education standards, familiarizes the fellow with the certification and recertification process and requirements, and provides a foundation to ensure that the fellow is a confident and functional part of the team early on in his or her prehospital experience.
5. CRITICAL CARE AND AIR MEDICAL TRANSPORT DIRECT MEDICAL OVERSIGHT TRAINING David Schoenfeld, Michael Cocchi, and Suzanne Wedel Boston MedFlight and Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts A broad experience in the provision of direct medical oversight (DMO) is a cornerstone of a strong EMS fellowship training program. One area to which programs may not have easy access is DMO for critical care and air medical transport services. This can be challenging because of the relatively few critical care transport programs, and the complexities inherent in these DMO cases. Through a partnership with
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VOLUME 19 / NUMBER 2
a regional critical care transport agency that provides fixed-wing, rotor-wing, and ground critical care transport, we developed a training program followed by practical experience in the provision of DMO for critical care and air medical transport. The program consists of a self-directed learning module that covers transport physiology, EMS and HEMS systems, state and regional laws/regulations governing air medical and critical care transport, flight safety, threat and error management, CAMTS standards, and the service protocols. Following a review of the material covered in the self-directed learning module, the fellow is assigned to one of the associate medical directors, and takes DMO calls along with the designated associate medical director for the remainder of the fellowship year, which creates a longitudinal mentoring experience. DMO is provided via a conference call patch between the critical care transport team, on-call associate medical director, EMS fellow, and other specialists, administrative staff, and/or aviation personnel as needed. This allows for a longitudinal experience in which the fellow initially listens to DMO contact and then transitions to an active role in providing the supervised DMO. Immediately following the DMO contact, real-time discussion and feedback with the associate medical director occurs. The fellow also receives a copy of the patient care report, and a selection of these calls are reviewed at monthly case conferences at the critical care program with the full transport team staff and medical directors. This program provides a unique longitudinal mentored experience providing DMO for air medical and critical care transport. Due to the design of the selfdirected learning module and DMO conference calls, this can be replicated at remote programs that would not otherwise have access to an air medical and critical care transport program.
6. FELLOW EVALUATION TOOL Marc S. Rosenthal, Robert Dunne, and Stefanie Wise Wayne State University, Detroit, Michigan The development of the approved EMS fellowship program requires development of evaluation tools that meet the needs of the fellowship with its diverse body of evaluators, including fellowship faculty, administrators, EMS agency directors, paramedics, EMTs, police officers, and fire personnel. We have created several tools to address the issues that reflect the competencies of the fellowship (Supplementary Figure 1, available online). The tools are based on the competencies and can be completed by any evaluator. We attempted to keep the language simple. There are com-
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FIGURE 1. Web-based communications system.
peting thoughts about specific versus general evaluation tools. Our goal was to create tools that are simple enough and consistent to allow electronic summation of the data. Three tools have been generated: a general evaluation tool, one specific to EMS personnel, and another specific to ancillary personnel, including police and fire personnel. Qualitatively these tools have been accepted by the evaluators as easy to use. We have created evaluation tools that allow evaluation of the EMS fellow based the fellowship competencies.
7. A NOVEL WEB-BASED COMMUNICATIONS SYSTEM FOR FACILITATING EMS PHYSICIAN SCENE RESPONSE Bjorn K. Peterson and Aaron M. Burnett Regions Hospital EMS, Saint Paul, Minnesota
Background: Agencies under the medical direction of Regions Hospital EMS span five counties, two states, seven dispatch centers, and eight radio talkgroups. Additionally, all patient reports and direct medical oversight requests are handled through a single radio base station (MRCC) via two additional radio talkgroups. Technical aspects limit the ability to simultaneously scan all relevant talkgroups, which results in missed dispatches and missed opportunities for our EMS fellow to provide online and on-scene medical oversight, both of which are crucial components of fellow education.
Problem: How do we ensure that our fellow is spending his or her response time in a way that is efficient and distributed across multiple geographically diverse EMS systems? How do we ensure that our fellow has adequate opportunity to provide online and on-scene medical oversight without creating unnecessary complexity? Solution: We created a web application to track incidents across all of our agencies in real time (Figure 1). This allows our fellow to monitor incidents without scanning multiple radio talkgroups. The application receives dispatch information directly from the dispatch centers by an automated e-mail page or audio file recorded from a VHF scanner. The incidents are automatically posted to the web application where turnby-turn directions can be obtained or the audio can easily be played back. The application also has features to facilitate communication with MRCC. In addition to a text-based chat system, the fellow can indicate he or she is “on air” via a toggle button. A corresponding display in the MRCC radio room allows an operator to page the “on air” fellow for medical oversight requests with a pop-up window and an SMS text message sent to the fellow’s cell phone. This request times out after 45 seconds if no acknowledgement is received, at which point the operator reverts to the on-duty ED physician for medical oversight. This system allows the fellow to easily monitor incidents throughout our service area as well as make himself/herself available for direct medical oversight requests. Constant radio monitoring is not required, and providers requesting medical oversight are able to maintain their normal operations.
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8. DEVELOPMENT OF A NOVEL COURSE TO INTEGRATE EMS FELLOW, EMERGENCY MEDICINE RESIDENT, AND UNDERGRADUATE EDUCATION IN EMS SYSTEMS ORGANIZATION AND DEPLOYMENT Joshua B. Gaither, Hans R. Bradshaw, Jennifer J. Smith, Kristina Waters, and Daniel Spaite
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University of Arizona, Tucson, Arizona Several groups of students in our university system expressed a need for formal instruction regarding EMS systems planning, organization, and operation. Potential students include undergraduate students (e.g., public health, premed, emergency management), medical students, residents, and fellows. We developed a course to address this need, focused on the structure of EMS systems and requiring no prerequisite medical education, making it broadly applicable to undergraduate, graduate, and post-doctoral students. The official undergraduate course at the University of Arizona is “EMD 350,” Emergency Medical Services, and entails a 3-credit, 45-hour course. It was offered during the summer session, coinciding with the first month of the one-year EMS fellowship. This education provided the fellow a foundation in EMS systems prior to extensive field time. Additionally, emergency medicine residents and residents on a specific EMS elective were able to participate to enhance their experiences. The course provides a broad overview of EMS medical care, the science behind EMS operations, and the legal framework under which prehospital care is delivered. Course topics included history of EMS, state and regional EMS systems, trauma systems, medical oversight, operations, financing, communications, documentation, information systems, transport, special populations, rural EMS, disaster response, public health, research, provider and system roles, occupational health, and medical–legal. Subspecialty EMS physicians enhance the EMS educational experience by delivering lectures on niche topics, such as tactical EMS, weapons of mass destruction, and community integrated paramedicine. The material is delivered in a didactic format with quizzes to reinforce core content. This curriculum meets the needs and interests of both undergraduate students and the residents/fellows, specifically providing some of the core content for EMS medicine. Core content topics include 2.2 EMS Systems, 2.3 EMS Personnel, 2.4 Systems Management, 3.0 Quality Management and Research, and portions of 4.0 Special Operations. Through this novel approach, we are able to successfully combine undergraduate EMS education with post-graduate medical education regarding several EMS system topics. This approach reduces the work-
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load on EMS faculty and provides the EMS fellow with a unique opportunity to teach in an undergraduate course.
9. INTEGRATED EXPERIENCE IN MASS CASUALTY INCIDENT MANAGEMENT FOR EMS FELLOWS AND EMERGENCY MEDICINE RESIDENTS Jeremiah T. Escajeda, Christian Martin-Gill, and Adam Z. Tobias University of Pittsburgh, Pittsburgh, Pennsylvania
Introduction: Mass casualty incident (MCI) training is a fundamental component of both EMS fellowship and emergency medicine (EM) residency training. We describe the development of a hospital-based live simulation MCI experience contributing providerlevel education for EM residents and a leadership role in drill preparation and incident management for EMS fellows. Exercise description: In coordination with EMS faculty and representatives from multiple departments of an academic, tertiary care, level I trauma center, the EMS fellow was engaged in planning and execution of a large-scale MCI simulation involving a train derailment and associated organophosphate exposure. In a 2-hour time period, a combination of live volunteer and manikin patients presented to the emergency department. EM residents were engaged in decontamination of patients with outside showers, triage using the START triage system, and the assessment and treatment of patients within graded treatment areas under the supervision of EM faculty. Leadership-level experience: During the planning phase and with assistance from an EMS faculty member, the EMS fellow led the design and preparation of the MCI experience. This included creating 50 patient cases with relevant assessment data, expected triage category, and expected medical interventions. Planning was undertaken to activate the system-wide disaster plan during the MCI event, involving an integrated response from multiple hospital departments and prehospital providers. The fellow designed the EM resident exercise curriculum, station assignments, and a didactic component on MCI management, and planned the supervision of residents during the exercise. Provider-level experience: First-year EM residents participated in the MCI drill through a rotating fourstation format: 1) primary assessment and performance of immediate life-saving interventions prior to decontamination, 2) decontamination, 3) triage, and 4) secondary assessment and treatment. Stations 1 and 2 included practice in application of level C personal
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protective equipment. Resident triage and interventions were evaluated by the EMS fellow and EMS faculty for adherence to the patient-specific plans developed for the MCI event. Summary: Through creation of an integrated experience in MCI management, EMS fellows and EM residents can respectively gain a leadership-level and provider-level understanding of planning and response to mass casualty events.
10. A NOVEL METHOD FOR OBTAINING PARAMEDIC FEEDBACK ON THE TEACHING ABILITIES OF AN EMS FELLOW Eric Cortez, James Davis, Karla Short, Anthony Brooks, and David Keseg Continuing education for the emergency medical services (EMS) provider is an important component of recertification, maintenance of licensure, and quality assurance. Continuing education sessions focused on applying, analyzing, and evaluating knowledge supplements traditional learning, with emphasis on the cognitive and affective learning domains. Previous studies have found that effective EMS provider education programs provide a stimulating learning environment, promote critical thinking activities, and present material in a patient-encounter format. We describe a novel method for evaluating our EMS fellow’s didactic and practical teaching skills. On July 1, 2013 we tasked our EMS fellow with developing a medical protocol review session focused on several cardiovascular-related topics. The sessions occurred every week from July 2013 through December 2013 and were 1 hour in length; approximately 10–20 paramedics were present for each session. The review
sessions provided not only continuing education and continuous quality improvement opportunities for our EMS system, but also a structured setting in which the EMS fellow was evaluated on several parameters. Our EMS fellow delivered the medical protocol review sessions to approximately 300 paramedics over the 6-month period. The sessions were supervised by the medial director for the EMS agency (also the EMS fellowship director). Following the completion of each session, paramedics were required to complete an online evaluation form in order to receive continuing education credit. The evaluation forms provided an anonymous means for our paramedics to comment on the abilities of the EMS fellow (didactic skills, leading discussions, usefulness and applicability of topics covered). Immediately following the review sessions, the EMS fellow was available for direct feedback from the paramedics as well. Overall, our paramedics appreciated the increased physician interactions, the case-based interactive dialogue, and the additional opportunities to discuss challenges in understanding protocol intent and applicability. With approximately 300 paramedics providing direct and indirect feedback, our EMS fellow was able to improve and refine his practical teaching skills, public speaking abilities, and application of adult learning theories.
SUPPLEMENTARY MATERIAL AVAILABLE ONLINE Supplementary Figure 1: Sample fellow evaluation tool Supplementary content can be viewed and downloaded at http:informahealthcare.com/pec.
ISSN: 1090-3127 (Print) 1545-0066 (Online) Journal homepage: http://www.tandfonline.com/loi/ipec20
Innovations in EMS Fellow Education To cite this article: (2015) Innovations in EMS Fellow Education, Prehospital Emergency Care, 19:2, 336-341 To link to this article: http://dx.doi.org/10.3109/10903127.2014.975880
View supplementary material
Published online: 06 Mar 2015.
Submit your article to this journal
Article views: 56
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipec20 Download by: [University of Nebraska, Lincoln]
Date: 05 November 2015, At: 16:46
NAEMSP FELLOW EDUCATION ABSTRACTS Downloaded by [University of Nebraska, Lincoln] at 16:46 05 November 2015
INNOVATIONS IN EMS FELLOW EDUCATION Presented here are the ten abstracts from the second annual “Innovations in EMS Fellow Education” poster session, held at the NAEMSP Annual Meeting in New Orleans in January 2015. All submissions were reviewed by a selection committee made up of representatives of the NAEMSP Education Committee, Program Committee, and Council of EMS Fellowship Directors. Abstracts chosen for presentation are listed here reverse alphabetically by the last name of the first author. The figure and table numbers match the abstract numbers.
ments, effecting technically challenging rescue evolutions while maintaining the health and safety of rescuers and support personnel. Confined space rescue training is part of the EMS medicine core content, but can be challenging to provide. We present a unique way to teach confined space entry and rescue techniques to an EMS fellow through collaboration with a local fire department. Recent construction of a new fire station allowed for opportunities to specifically design original unique training areas within the structure to provide ready access to a variety of confined space training scenarios. Features include multiple hard points for rope work, a variety of utility models, and even floodable spaces in the basement of the structure. Due to the unique design, training can occur at any time with minimal setup and instructor preparations. These conditions could be modified for other departments, providing a ready “hands on” experience in confined space training for fellows and other learners.
1. TEACHING CONFINED SPACE RESCUE TECHNIQUES UTILIZING DEDICATED TRAINING FEATURES EMBEDDED IN OPERATIONAL FACILITIES David Wilcocks, George Lindbeck, Charles Werner, Linda Johnson, and Debra Perina University of Virginia, Charlottesville, Virginia
2. A NOVEL METHOD OF TEACHING SYSTEM DESIGN TO EMS FELLOWS
“Confined space” refers to an enclosed area with limited access presenting unique challenges to rescue operations. Examples include tunnels, storage tanks, silos, pits, manholes, ductwork, or pipes. Hazards in a confined space include suffocation by unbreathable gases, submersion in liquids or free-flowing granular solids (e.g., grain bins), collapse of unstable structures, or electrocution. Confined space emergencies are of particular concern because multiple casualties can occur when untrained rescuers succumb to the same hazard as the initial victim. Confined space training prepares rescuers to safely enter hazardous environ-
Bridgette Svancarek, Scott W. Gilmore, and Phillip H. Moy Washington University, St. Louis, Missouri Learning system design is one of the most difficult topics in EMS. Teaching it effectively is equally challenging. EMS system design is an extremely complex topic without a defined perfect delivery model. The Washington University EMS Fellowship has an effective and interesting way to overcome the challenges of teaching the concepts of system design. The Saint Louis area has several types of EMS systems (Table 2). The fellowship at Washington University is privileged to have a close working relationship with these various systems. The EMS fellows visit each agency and meet with the medical director and other EMS experts. During these meetings the following are
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the abstracts. doi: 10.3109/10903127.2014.975880
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TABLE 2. Teaching system design Type of EMS system
Third service
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Fire-based Hospital-based Private Air medical
Location
St. Charles County Ambulance District (SCCAD) St. Louis City Fire Department Christian Hospital EMS Abbott EMS (AMR) Air-Evac Lifeteam
discussed: the service delivery model, unit hour utilization ratios, special challenges the model faces, reimbursement, performance of QA/QI, and dispatch design. In addition, the fellow learns if the system uses tiered responses, flexible or specialized production strategy, static or dynamic deployment, and peak load staffing. Using this technique, the fellow learns about the diverse types of EMS delivery models and advantages and disadvantages of each. This allows the fellow to compare and contrast the numerous system delivery models and identify features unique to each system. He or she can recognize what makes a system economically efficient and clinically sophisticated, and learn how to perform system status management. This teaching style goes beyond reading the complex details of system design in a textbook or sitting in a lecture. Upon completion, the fellow is asked to design a hypothetical EMS system. Subsequently, the fellow must identify what characteristics make his or her system design superior. This allows the fellow to truly understand system design through the use of synthesis. In the end, the purpose of this teaching method is to provide our fellows with the tools to develop their own high-quality system design.
3. LONGITUDINAL EMERGENCY MEDICAL SERVICES TRACK CURRICULUM FOR EMERGENCY MEDICINE RESIDENTS IMPROVES EMS MEDICAL DIRECTION AND FELLOWSHIP CAREER PLACEMENT Andrew Stevens, Dan O’Donnell, Charlie Miramonti, and Michael Olinger Indiana University School of Medicine, Indianapolis, Indiana
Background: All residency-trained emergency physicians participate in mandated emergency medical services (EMS) education. Often emergency physicians are asked to assume medical director roles. We hypothesized that longitudinal EMS resident education provides a better model for career-sustaining EMS medical director concepts.
Objective: Implement a novel comprehensive EMS curricular track in EM residency to increase fellowship and EMS medical director career placement postgraduate training. Methods: We designed a survey to assess baseline EMS medical directorship participation. The survey was electronically administered to a cohort of EM alumni from a single academic institution. Survey feedback was used in developing a novel curriculum in 2010. This longitudinal EMS track curriculum requires residents to assume a 2-year EMS medical directorship in a large urban EMS system. Graded experience is acquired through the following components: 1) active member of a resident-paramedic prehospital ambulance unit (PGY-2); 2) independent prehospital supervisory provider (PGY-3); 3) participation in an EMS subspecialty niche (e.g., mass gathering, disaster, tactical, motorsports, air medicine). Quarterly meetings, quality improvement projects, and fellowship-trained EMS faculty mentors supplement the curriculum. Residents complete scholarly and administrative requirements within the track. Education is formalized by completion of a nationally recognized EMS medical director course as a capstone experience. Results: Fifty-six alumni participated in the survey (37% response rate), and of these, 11 (19%) selfidentified as EMS medical directors. Twenty-three residents have completed the EMS track curriculum from 2010 to date and of these, 21 (91%, p < 0.0001) were successfully placed: 14 (67%) as EMS medical directors and 7 (33%) as fellows. Conclusion: Longitudinal EMS track curricula with graded responsibilities provide a better model to teach medical director skills during residency. This model enhances EMS career development and better prepares emergency medicine resident graduates for fellowship and medical director roles.
4. EMT IMMERSION CURRICULUM FOR EMS FELLOWS WITHOUT PRIOR EMT EXPERIENCE David Schoenfeld, Paul Roszko, and Jonathan Fisher Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts A critical component to EMS fellowship education is the field experience gained during the program. Incoming fellows may have little or no prehospital experience, and may never have trained on some of the skills that are considered basic or routine for EMS providers. As part of our fellowship didactics, we developed a longitudinal curriculum that 1) addresses the need to provide fellows with fundamental EMT skills, 2) highlights the education for varying levels of field providers, 3) exposes fellows to the initial EMT
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338 certification requirements, and 4) familiarizes them with the recertification requirements for EMTs and paramedics. The program begins with a 20-hour condensed EMT course that focuses on the skills and knowledge base covered in the EMT portion of the National EMS Education Standards. The course is taught through a combination of independent reading and hands-on skill/simulation training. The sessions are taught by the clinical field supervisors (paramedics) at the fellowship’s EMS agency providing the primary field experience. This helps develop a relationship between the fellow and the field supervisors he/she will work with throughout the year. Basic EMT medications are reviewed through case-based scenarios delivered in a format similar to the EMT exam psychomotor skills station. In addition to these practical skills, there is also a focus on basic ambulance operations such as stretcher operation, lifting/moving, radio operation and etiquette, scene safety and management, and special operations. The fellow then challenges the NREMT EMT certification exam, which verifies assimilation of EMT knowledge and skills and builds “street cred” with the EMTs for whom the fellow will be providing medical oversight. During the remainder of the longitudinal program, the fellow continues to navigate the paramedic skills and knowledge base through skills stations and simulation training, ultimately challenging the NREMT paramedic certification exam. This program provides a structured mechanism that covers core clinical content and EMT/paramedic training and education standards, familiarizes the fellow with the certification and recertification process and requirements, and provides a foundation to ensure that the fellow is a confident and functional part of the team early on in his or her prehospital experience.
5. CRITICAL CARE AND AIR MEDICAL TRANSPORT DIRECT MEDICAL OVERSIGHT TRAINING David Schoenfeld, Michael Cocchi, and Suzanne Wedel Boston MedFlight and Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts A broad experience in the provision of direct medical oversight (DMO) is a cornerstone of a strong EMS fellowship training program. One area to which programs may not have easy access is DMO for critical care and air medical transport services. This can be challenging because of the relatively few critical care transport programs, and the complexities inherent in these DMO cases. Through a partnership with
PREHOSPITAL EMERGENCY CARE
APRIL/JUNE 2015
VOLUME 19 / NUMBER 2
a regional critical care transport agency that provides fixed-wing, rotor-wing, and ground critical care transport, we developed a training program followed by practical experience in the provision of DMO for critical care and air medical transport. The program consists of a self-directed learning module that covers transport physiology, EMS and HEMS systems, state and regional laws/regulations governing air medical and critical care transport, flight safety, threat and error management, CAMTS standards, and the service protocols. Following a review of the material covered in the self-directed learning module, the fellow is assigned to one of the associate medical directors, and takes DMO calls along with the designated associate medical director for the remainder of the fellowship year, which creates a longitudinal mentoring experience. DMO is provided via a conference call patch between the critical care transport team, on-call associate medical director, EMS fellow, and other specialists, administrative staff, and/or aviation personnel as needed. This allows for a longitudinal experience in which the fellow initially listens to DMO contact and then transitions to an active role in providing the supervised DMO. Immediately following the DMO contact, real-time discussion and feedback with the associate medical director occurs. The fellow also receives a copy of the patient care report, and a selection of these calls are reviewed at monthly case conferences at the critical care program with the full transport team staff and medical directors. This program provides a unique longitudinal mentored experience providing DMO for air medical and critical care transport. Due to the design of the selfdirected learning module and DMO conference calls, this can be replicated at remote programs that would not otherwise have access to an air medical and critical care transport program.
6. FELLOW EVALUATION TOOL Marc S. Rosenthal, Robert Dunne, and Stefanie Wise Wayne State University, Detroit, Michigan The development of the approved EMS fellowship program requires development of evaluation tools that meet the needs of the fellowship with its diverse body of evaluators, including fellowship faculty, administrators, EMS agency directors, paramedics, EMTs, police officers, and fire personnel. We have created several tools to address the issues that reflect the competencies of the fellowship (Supplementary Figure 1, available online). The tools are based on the competencies and can be completed by any evaluator. We attempted to keep the language simple. There are com-
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FIGURE 1. Web-based communications system.
peting thoughts about specific versus general evaluation tools. Our goal was to create tools that are simple enough and consistent to allow electronic summation of the data. Three tools have been generated: a general evaluation tool, one specific to EMS personnel, and another specific to ancillary personnel, including police and fire personnel. Qualitatively these tools have been accepted by the evaluators as easy to use. We have created evaluation tools that allow evaluation of the EMS fellow based the fellowship competencies.
7. A NOVEL WEB-BASED COMMUNICATIONS SYSTEM FOR FACILITATING EMS PHYSICIAN SCENE RESPONSE Bjorn K. Peterson and Aaron M. Burnett Regions Hospital EMS, Saint Paul, Minnesota
Background: Agencies under the medical direction of Regions Hospital EMS span five counties, two states, seven dispatch centers, and eight radio talkgroups. Additionally, all patient reports and direct medical oversight requests are handled through a single radio base station (MRCC) via two additional radio talkgroups. Technical aspects limit the ability to simultaneously scan all relevant talkgroups, which results in missed dispatches and missed opportunities for our EMS fellow to provide online and on-scene medical oversight, both of which are crucial components of fellow education.
Problem: How do we ensure that our fellow is spending his or her response time in a way that is efficient and distributed across multiple geographically diverse EMS systems? How do we ensure that our fellow has adequate opportunity to provide online and on-scene medical oversight without creating unnecessary complexity? Solution: We created a web application to track incidents across all of our agencies in real time (Figure 1). This allows our fellow to monitor incidents without scanning multiple radio talkgroups. The application receives dispatch information directly from the dispatch centers by an automated e-mail page or audio file recorded from a VHF scanner. The incidents are automatically posted to the web application where turnby-turn directions can be obtained or the audio can easily be played back. The application also has features to facilitate communication with MRCC. In addition to a text-based chat system, the fellow can indicate he or she is “on air” via a toggle button. A corresponding display in the MRCC radio room allows an operator to page the “on air” fellow for medical oversight requests with a pop-up window and an SMS text message sent to the fellow’s cell phone. This request times out after 45 seconds if no acknowledgement is received, at which point the operator reverts to the on-duty ED physician for medical oversight. This system allows the fellow to easily monitor incidents throughout our service area as well as make himself/herself available for direct medical oversight requests. Constant radio monitoring is not required, and providers requesting medical oversight are able to maintain their normal operations.
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8. DEVELOPMENT OF A NOVEL COURSE TO INTEGRATE EMS FELLOW, EMERGENCY MEDICINE RESIDENT, AND UNDERGRADUATE EDUCATION IN EMS SYSTEMS ORGANIZATION AND DEPLOYMENT Joshua B. Gaither, Hans R. Bradshaw, Jennifer J. Smith, Kristina Waters, and Daniel Spaite
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University of Arizona, Tucson, Arizona Several groups of students in our university system expressed a need for formal instruction regarding EMS systems planning, organization, and operation. Potential students include undergraduate students (e.g., public health, premed, emergency management), medical students, residents, and fellows. We developed a course to address this need, focused on the structure of EMS systems and requiring no prerequisite medical education, making it broadly applicable to undergraduate, graduate, and post-doctoral students. The official undergraduate course at the University of Arizona is “EMD 350,” Emergency Medical Services, and entails a 3-credit, 45-hour course. It was offered during the summer session, coinciding with the first month of the one-year EMS fellowship. This education provided the fellow a foundation in EMS systems prior to extensive field time. Additionally, emergency medicine residents and residents on a specific EMS elective were able to participate to enhance their experiences. The course provides a broad overview of EMS medical care, the science behind EMS operations, and the legal framework under which prehospital care is delivered. Course topics included history of EMS, state and regional EMS systems, trauma systems, medical oversight, operations, financing, communications, documentation, information systems, transport, special populations, rural EMS, disaster response, public health, research, provider and system roles, occupational health, and medical–legal. Subspecialty EMS physicians enhance the EMS educational experience by delivering lectures on niche topics, such as tactical EMS, weapons of mass destruction, and community integrated paramedicine. The material is delivered in a didactic format with quizzes to reinforce core content. This curriculum meets the needs and interests of both undergraduate students and the residents/fellows, specifically providing some of the core content for EMS medicine. Core content topics include 2.2 EMS Systems, 2.3 EMS Personnel, 2.4 Systems Management, 3.0 Quality Management and Research, and portions of 4.0 Special Operations. Through this novel approach, we are able to successfully combine undergraduate EMS education with post-graduate medical education regarding several EMS system topics. This approach reduces the work-
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load on EMS faculty and provides the EMS fellow with a unique opportunity to teach in an undergraduate course.
9. INTEGRATED EXPERIENCE IN MASS CASUALTY INCIDENT MANAGEMENT FOR EMS FELLOWS AND EMERGENCY MEDICINE RESIDENTS Jeremiah T. Escajeda, Christian Martin-Gill, and Adam Z. Tobias University of Pittsburgh, Pittsburgh, Pennsylvania
Introduction: Mass casualty incident (MCI) training is a fundamental component of both EMS fellowship and emergency medicine (EM) residency training. We describe the development of a hospital-based live simulation MCI experience contributing providerlevel education for EM residents and a leadership role in drill preparation and incident management for EMS fellows. Exercise description: In coordination with EMS faculty and representatives from multiple departments of an academic, tertiary care, level I trauma center, the EMS fellow was engaged in planning and execution of a large-scale MCI simulation involving a train derailment and associated organophosphate exposure. In a 2-hour time period, a combination of live volunteer and manikin patients presented to the emergency department. EM residents were engaged in decontamination of patients with outside showers, triage using the START triage system, and the assessment and treatment of patients within graded treatment areas under the supervision of EM faculty. Leadership-level experience: During the planning phase and with assistance from an EMS faculty member, the EMS fellow led the design and preparation of the MCI experience. This included creating 50 patient cases with relevant assessment data, expected triage category, and expected medical interventions. Planning was undertaken to activate the system-wide disaster plan during the MCI event, involving an integrated response from multiple hospital departments and prehospital providers. The fellow designed the EM resident exercise curriculum, station assignments, and a didactic component on MCI management, and planned the supervision of residents during the exercise. Provider-level experience: First-year EM residents participated in the MCI drill through a rotating fourstation format: 1) primary assessment and performance of immediate life-saving interventions prior to decontamination, 2) decontamination, 3) triage, and 4) secondary assessment and treatment. Stations 1 and 2 included practice in application of level C personal
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protective equipment. Resident triage and interventions were evaluated by the EMS fellow and EMS faculty for adherence to the patient-specific plans developed for the MCI event. Summary: Through creation of an integrated experience in MCI management, EMS fellows and EM residents can respectively gain a leadership-level and provider-level understanding of planning and response to mass casualty events.
10. A NOVEL METHOD FOR OBTAINING PARAMEDIC FEEDBACK ON THE TEACHING ABILITIES OF AN EMS FELLOW Eric Cortez, James Davis, Karla Short, Anthony Brooks, and David Keseg Continuing education for the emergency medical services (EMS) provider is an important component of recertification, maintenance of licensure, and quality assurance. Continuing education sessions focused on applying, analyzing, and evaluating knowledge supplements traditional learning, with emphasis on the cognitive and affective learning domains. Previous studies have found that effective EMS provider education programs provide a stimulating learning environment, promote critical thinking activities, and present material in a patient-encounter format. We describe a novel method for evaluating our EMS fellow’s didactic and practical teaching skills. On July 1, 2013 we tasked our EMS fellow with developing a medical protocol review session focused on several cardiovascular-related topics. The sessions occurred every week from July 2013 through December 2013 and were 1 hour in length; approximately 10–20 paramedics were present for each session. The review
sessions provided not only continuing education and continuous quality improvement opportunities for our EMS system, but also a structured setting in which the EMS fellow was evaluated on several parameters. Our EMS fellow delivered the medical protocol review sessions to approximately 300 paramedics over the 6-month period. The sessions were supervised by the medial director for the EMS agency (also the EMS fellowship director). Following the completion of each session, paramedics were required to complete an online evaluation form in order to receive continuing education credit. The evaluation forms provided an anonymous means for our paramedics to comment on the abilities of the EMS fellow (didactic skills, leading discussions, usefulness and applicability of topics covered). Immediately following the review sessions, the EMS fellow was available for direct feedback from the paramedics as well. Overall, our paramedics appreciated the increased physician interactions, the case-based interactive dialogue, and the additional opportunities to discuss challenges in understanding protocol intent and applicability. With approximately 300 paramedics providing direct and indirect feedback, our EMS fellow was able to improve and refine his practical teaching skills, public speaking abilities, and application of adult learning theories.
SUPPLEMENTARY MATERIAL AVAILABLE ONLINE Supplementary Figure 1: Sample fellow evaluation tool Supplementary content can be viewed and downloaded at http:informahealthcare.com/pec.
